Clinical medicine (London, England)
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Prescribing for older adults represents a significant challenge as the UK population ages. Physiological decline and the rising prevalence of frailty increase the likelihood of altered pharmacodynamics and pharmacokinetics, suboptimal prescribing and adverse effects among this growing cohort of the population. ⋯ Does this agent reflect the priorities of the patient? Are there alternatives - with greater efficacy, effectiveness or tolerability - that might be considered? Are the dose, frequency and formulation appropriate? How does this prescription relate to concurrent medication? We also describe current drug therapies in two disease states with a predilection for older adults: Alzheimer's disease (AD) and osteoporosis. Using these examples we highlight the limitations of evidence-based medicine and guidelines in this cohort of the population, illustrating the reliance on sub-group analysis to demonstrate the efficacy of drug therapies for older adults in osteoporosis and the underutilisation of appropriate treatments for patients with AD as a result of flawed guidelines.
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Dengue is one of the most rapidly emerging viral infections globally, with 2.5 billion people now thought to live in dengue-endemic areas. In addition, reports of travel-related and autochthonous infections are increasing in non-endemic areas. ⋯ As dengue can present with non-specific symptoms of fever, headache and myalgias, the potential for misdiagnosis and inappropriate management by medical staff inexperienced with the disease is a concern. This short review will outline the latest World Health Organisation disease classification, potential complications, clinical assessment and management for clinicians working in non-endemic areas.
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Tick-borne infections are seen throughout the United States, with varying geographical locations. Many of these infections are also increasingly seen in Europe. Certain ticks (eg Ixodes) can transmit more than one infection. ⋯ In certain situations, empiric therapy may be required for tick-borne infections as severe illness with multiorgan failure can occur, particularly in older and immunocompromised hosts. This review describes the more commonly seen tick-borne infections: Lyme, babesiosis, anaplasmosis and Rocky Mountain Spotted Fever. More recently identified tick-borne infections, such as southern tick-associated rash illness and Borrelia miyamotoi, are also covered.
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Idiopathic pulmonary fibrosis (IPF) is a devastating condition with a poor prognosis and few treatment options. However, recent research into this condition has led to considerable insights into the pathophysiology of the disease, resulting in the identification of potential biomarkers to aid diagnosis and stratification of patients and the development of novel therapies. In this review we will discuss the recent developments in this field and review how this knowledge has been translated into clinical trials and a paradigm shift in our approach to patients with IPF.
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Kidney transplants do not last for the natural lifespan of most recipients. Of the reasons why transplants fail, damage by the immune system is the commonest cause. Understanding how the immune system recognises transplanted organs has increased significantly in recent years, but there is little insight into how organs are damaged, and no still no way of suppressing immune-mediated damage without exposing patients to the detrimental effects of long-term immunosuppression. In this article, we review the role of antibodies and B cells in immune-mediated damage of kidney transplants, and discuss the potential for manipulation of B cells to improve clinical outcomes.